本文選題：腹膜透析　切入點(diǎn)：人口統(tǒng)計(jì)學(xué)　出處：《浙江大學(xué)》2016年博士論文

【摘要】：第一部分 浙江省腹膜透析患者人口統(tǒng)計(jì)學(xué)分析目的浙江省透析質(zhì)量控制中心(Zhejiang Dialysis Quality and Management Center, ZDQM)登記腹膜透析患者相關(guān)信息,包括患者基本信息、病情轉(zhuǎn)歸、實(shí)驗(yàn)室檢查結(jié)果等。本研究對(duì)2008-2015年ZDQM登記的腹膜透析患者資料進(jìn)行分析,探究浙江省腹膜透析人群現(xiàn)況。方法數(shù)據(jù)來(lái)源于ZDQM數(shù)據(jù)庫(kù),各項(xiàng)數(shù)據(jù)內(nèi)容均通過(guò)各中心網(wǎng)絡(luò)在線填報(bào)并收集匯總。時(shí)間以2015年12月31日為止,導(dǎo)出數(shù)據(jù)庫(kù)內(nèi)所有錄入腹膜透析患者的基本信息,包括出生日期、性別、診斷、首次透析日期、轉(zhuǎn)歸情況及原因、轉(zhuǎn)歸日期等。對(duì)其發(fā)病率、點(diǎn)患病率、年齡及性別構(gòu)成、原發(fā)病病因、死亡時(shí)間及原因等進(jìn)行統(tǒng)計(jì)分析。結(jié)果2008-2015年浙江省共有9145例腹膜透析患者登記。點(diǎn)患病率從14.16/百萬(wàn)人口上升至106.52/百萬(wàn)人口；新增患者平均年齡從49.94歲(2009年)上升至54.10歲(2015年)；在透患者平均年齡從52.41歲上升至55.19歲,以45-65歲患者為主體人群,65歲以上人群從22.4%上升至27.3%；男性患者多于女性患者；在透患者的平均透析齡從1.63年上升至2.73年,透析齡大于4年的患者比例由6.1%增長(zhǎng)至23.0%。原發(fā)病病因前三位依次是慢性腎小球腎炎(占全體已知病因61.5%),糖尿病腎病(占12.8%)和高血壓腎病(占8.8%)。退出腹膜透析登記系統(tǒng)患者占35.48%,其中轉(zhuǎn)血液透析8.9%,腎移植6.5%,死亡11.0%；死亡原因以心腦血管事件為主,占30.5%,其次為感染(占10.8%)及惡性腫瘤(占5.4%)。轉(zhuǎn)腎移植患者人數(shù)逐年增加,從2008年23人增長(zhǎng)至2014年的124人。結(jié)論2008-2015年浙江省腹膜透析患病率持續(xù)上升,患者平均年齡逐漸增長(zhǎng),老年患者比例逐年上升,透析齡逐年增加,原發(fā)病以慢性腎小球腎炎為主,心腦血管事件為腹膜透析患者的主要死因,轉(zhuǎn)腎移植患者數(shù)量逐年增加。第二部分 腹膜透析患者預(yù)后及相關(guān)因素分析目的腹膜透析患者死亡風(fēng)險(xiǎn)高于普通人群,對(duì)ZDQM數(shù)據(jù)庫(kù)中腹膜透析患者的資料信息及實(shí)驗(yàn)室基線數(shù)據(jù)進(jìn)行回顧性分析,探究浙江省腹膜透析患者生存率及技術(shù)生存率的相關(guān)影響因素。方法數(shù)據(jù)來(lái)源于ZDQM數(shù)據(jù)庫(kù),以2015年12月31日為止,選取首次透析時(shí)年齡大于等于18歲、透析時(shí)間大于90天、轉(zhuǎn)歸情況明確及實(shí)驗(yàn)室基線數(shù)據(jù)全面的腹膜透析患者,統(tǒng)計(jì)患者開(kāi)始透析時(shí)的基本信息、診斷、實(shí)驗(yàn)室結(jié)果等,采用Kaplan-Meier曲線、Log-Rank檢驗(yàn)、及單因素Cox生存分析進(jìn)行單因素分析,篩選出有統(tǒng)計(jì)學(xué)意義的因素進(jìn)行多因素Cox生存分析,探究腹膜透析患者生存率及技術(shù)生存率的獨(dú)立影響因素。結(jié)果浙江省腹膜透析患者1年、3年及5年的累計(jì)患者生存率分別為96.0%,87.3%,80.3%；1年、3年及5年的累計(jì)技術(shù)生存率分別為96.5%,87.2%,73.3%；多因素生存分析提示腫瘤病史(校正HR4.875,95%CI 1.530-15.537, P=0.007),初始年齡≥65歲(校正HR 2.807,95%CI 1.823-4.322, P0.001), C反應(yīng)蛋白≥4mg/L(校正HR 1.984,95%CI 1.280-3.076, P=0.002),血清白蛋白≥35g/L(校正HR0.454,95%CI0.271-0.763, P=0.003)是腹膜透析患者生存率的獨(dú)立影響因素；腹膜透析導(dǎo)管相關(guān)并發(fā)癥(校正HR 4.674,95%CI 1.708-12.789, P=0.003),血清鐵蛋白350≥ng/ml(校正HR 1.673,95%CI 1.097-2.549, P=0.017),女性(校正HR 0.612,95%CI 0.402-0.931, P=0.022)是腹膜透析技術(shù)生存率的獨(dú)立影響因素。結(jié)論腫瘤病史、高齡、高C反應(yīng)蛋白為腹膜透析患者生存率獨(dú)立危險(xiǎn)因素,高血清白蛋白為保護(hù)因素；腹膜透析導(dǎo)管相關(guān)并發(fā)癥、高血清鐵蛋白為腹膜透析技術(shù)生存率的獨(dú)立危險(xiǎn)因素,女性為保護(hù)因素。
[Abstract]:The first part of the statistical analysis in patients with peritoneal dialysis population in Zhejiang province to Zhejiang province dialysis quality control center (Zhejiang Dialysis Quality and Management Center, ZDQM) related information registration in peritoneal dialysis patients, including basic information, patient outcomes, laboratory examination results. This study is registered for 2008-2015 years ZDQM in peritoneal dialysis patients were analyzed retrospectively, explore the status of peritoneal dialysis in Zhejiang province population. Methods the data from the ZDQM database, the data center network content through the online reporting and collection time. By December 31, 2015, all entries in peritoneal dialysis patients basic information derived from the database, including the date of birth, gender, diagnosis, prognosis and date of dialysis for the first time, reason, vesting date. The incidence, point prevalence, age and gender, the etiology of primary disease, death time and causes Statistical analysis was carried out. The result of 2008-2015 years of Zhejiang province has a total of 9145 cases of peritoneal dialysis patients. The registration point prevalence from 14.16/ million population increased to 106.52/ million; increase the average age of the patients at the age of 49.94 (2009) up to 54.10 years of age (2015); in hemodialysis patients with Ping Junnian age increased from 52.41 years old to 55.19 years old, to a 45-65 year old patient population as the main body, 65 people over the age increased from 22.4% to 27.3%; male patients than female patients; the average age of dialysis hemodialysis patients rose from 1.63 to 2.73 years, more than 4 years of dialysis age the proportion of patients increased from 6.1% to 23.0%. causes the first three followed by the primary disease of chronic glomerulonephritis (accounted for all the 61.5% known cause), diabetic nephropathy (12.8%) and hypertensive nephropathy (8.8%). Exit registration system of peritoneal dialysis patients accounted for 35.48%, of which around 8.9% hemodialysis, 6.5% kidney transplantation, 11% died; cause of death Cardiovascular and cerebrovascular events, accounting for 30.5%, followed by infection (10.8%) and malignant tumors (5.4%). The number of renal transplant patients increased year by year, from 124 in 2008 to 23 growth in 2014 to 2008-2015 years in Zhejiang province. Conclusion the prevalence rate of peritoneal dialysis patients continued to rise, the age of Ping Junnian gradually increased, the proportion of elderly patients rise, dialysis age increased year by year, with primary disease of chronic glomerulonephritis, cardiovascular and cerebrovascular events were the main causes of death in patients with peritoneal dialysis, to number of renal transplant patients increased year by year. In the second part, the prognosis of patients with peritoneal dialysis and related factors analysis of peritoneal dialysis patients' risk of death than the general population, the information and laboratory baseline data of patients with peritoneal dialysis in ZDQM database were analyzed retrospectively, to explore the influence factors related to peritoneal dialysis in Zhejiang province with survival rate and survival rate. The technology method of data From the ZDQM database, in December 31, 2015 for the first time, selection of dialysis age more than 18 years, dialysis time more than 90 days, the outcome of peritoneal dialysis patients clear and laboratory comprehensive baseline data, basic information, statistics at the beginning of dialysis patients diagnosis, laboratory results, using the Kaplan-Meier curve, Log-Rank test and single the survival analysis of Cox factors were analyzed by univariate analysis, significant factors were screened by Cox multivariate survival analysis, explore the independent factors affecting the survival of peritoneal dialysis patients and survival. Results of peritoneal dialysis in Zhejiang Province in 1 years, 3 years and 5 years of cumulative survival rate were 96%, 87.3%, 80.3%; 1 years, 3 years and 5 years of accumulated technology survival rates were 96.5%, 87.2%, 73.3%; multivariate survival analysis showed that the history of cancer (adjusted HR4.875,95%CI 1.530-15.537, P=0.007), the initial year Age greater than 65 years (adjusted HR 2.807,95%CI 1.823-4.322, P0.001), C reactive protein (adjusted HR = 4mg/L 1.984,95%CI 1.280-3.076, P=0.002), serum albumin was 35g/L (adjusted HR0.454,95%CI0.271-0.763, P=0.003) is the survival of peritoneal dialysis patients independent factors; peritoneal dialysis catheter related complications (HR 4.674,95%CI 1.708-12.789 P=0.003 correction, serum). Ferritin 350 = ng/ml (HR 1.673,95%CI 1.097-2.549 P=0.017 correction, (HR), female 0.612,95%CI 0.402-0.931 correction, P=0.022) were independent factors affecting the survival rate of peritoneal dialysis technology. Conclusion the old history of cancer, C, high C-reactive protein in peritoneal dialysis patients survival rate independent risk factors and protective factors for high serum albumin; peritoneal dialysis catheter related complications, high serum ferritin as independent risk factors of survival rate of peritoneal dialysis technology, women were protective factors.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R692.5

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